Provider Demographics
NPI:1679228217
Name:BAPTISTA, LUCRECIA
Entity Type:Individual
Prefix:MRS
First Name:LUCRECIA
Middle Name:
Last Name:BAPTISTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-140 HAILIPO ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-2346
Mailing Address - Country:US
Mailing Address - Phone:808-368-4724
Mailing Address - Fax:808-689-4908
Practice Address - Street 1:91-140 HAILIPO ST
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-2346
Practice Address - Country:US
Practice Address - Phone:808-368-4724
Practice Address - Fax:808-689-4908
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI5109922311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI510992OtherMEDICARE PRIVATE/MEDICARE